The spread of infectious diseases through whirlpool baths and hydrotherapy tanks is well documented. For example, see Ringham, S., "A Whirlpool of bacteria . . . therapy bath . . . vector of cross-infection," Nursing Times 1989, Vol. 85, pp. 77, 80; Spitalny, K. C., "National survey on outbreaks associated with whirlpool spas," Am. J. Public Health 1984, Vol 74, pp. 725-6; Crandall, R. A. "Pathogenic hazards and public spa and hot tub facilities," Can. J. Public Health 1984, Vol 75, pp. 223-6; Shaw, J. W., "A retrospective of the effectiveness of bromination and chlorination in controlling Pseudomonas Aeruginosa in spas (whirlpools) in Alberta," Can. J. Public Health 1984, Vol. 75, pp. 61-8; Mangione, E., et al., "An outbreak of Pontiac Fever related to whirlpool use, Michigan 1982," J.A.M.A. 1985, Vol. 253, pp. 535-39; Salmen, P., et al., "Whirlpool-associated Pseudomonas Aeruginosa urinary tract infections," J.A.M.A. 1983, Vol 250, pp. 2025-26; and Rose, H. D., et al., "Pseudomonas Pneumonia associated with use of a home whirlpool spa," J.A.M.A. 1983, Vol. 250, pp. 2027-29.
Occupational and physical therapists often provide patients with whirlpool baths. Whirlpool baths are also commonly utilized as a heat modality, to debride open wounds, to relax muscles, to facilitate range of motion treatments, to soften tissue, to increase blood flow, to relieve pain, to increase the extensibility of collagen tissue, to decrease joint stiffness, and to increase tendon excursion following surgical repair.
It is often impossible for a health care provider to determine whether an individual is a carrier of an infectious disease that might be transferred to subsequent users of a whirlpool bath.
Ideally all baths should be thoroughly disinfected between whirlpool treatments. However, baths are often not cleaned and disinfected between uses due to time and cost constraints. Additionally, even thorough cleaning of baths does not assure that all pathogens have been removed or rendered harmless.
The literature has also reported that homosexuals are frequent patrons of bath-houses. See, for example, McKusick, L., et al., "Reported changes in the sexual behavior of men at risk for AIDS," Public health Rep. 1985, Vol 100(6), pp. 622-29; and McKusick. L., et al., "AIDS and sexual behavior reported by gay men in San Francisco," Am. J. Public Health 1985, Vol. 75(5), pp. 493-36.
AIDS or "acquired immunodeficiency syndrome" is a deadly disease for which there is no known cure. Many individuals carry the virus that causes AIDS without exhibiting any AIDS symptoms, and it is impossible for a bath-house proprietor to assess the relative health of an individual prior to allowing that individual access to a bath.
Health care providers and bath-house proprietors are desirous of a means of reducing the risk of cross infecting their patients and patrons.